Climbing My Way Out of Hypoglycemia (Finally!)

After a visit to the endocrinologist last week, I feel as if I’m finally getting a handle on my blood glucose — thanks to a good doctor who knows what he’s doing and can commit math!

As an insulin-resistant Type 2, I use a lot of insulin. My basal rate alone had been in the 150-unit-per-day range. Then I began running low. This has been happening lately. I run low for a while, then BOOM! I go high. I get the basal rates on my insulin pump adjusted to take care of the highs. That works for a while, then BOOM! I go low. I don’t recall that anything much changes in terms of diet or activity.

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Does anybody else do that? I kind of get the impression my endo is puzzled, too.

At any rate, I’d gotten my basal rates down into the 130’s. He lowered them into the 120’s while I was at my visit.

Are we finished? Are you kidding? I’m in the throes of keeping a record of every gram of carbohydrate I put into my mouth, every unit of insulin I infuse into my body, and the times I do each.

I have three more days of that, then I’ll fax that page to him, along with a week’s printout from my continuous glucose monitor (CGM). He can overlay the two — mentally if not physically — and tighten up my basal rates along with figuring out if my insulin-to-carbohydrate ratio and correction factor need to be adjusted.

All that translates to is that I need to be as precise as possible in counting my carbs. I’ve not done a lot of guesstimating the past few days. I’d say…oh…only the one when my husband made spaghetti and meatballs for dinner one night. When your Sweet Baboo tells you he has the ingredients and is making one of your favorite dishes, you don’t say “no.” I just pulled a number out of the air, put a question mark after it and put “pasta” in the comments section.

Then it’ll be Passover, my whole diet will change for eight days, and who knows what will happen.

What would we do for excitement if we didn’t have diabetes?

As I’ve been writing, I’ve been thinking, “this doesn’t sound a lot like the way somebody with Type 2 diabetes acts!” Aren’t we supposed to be clueless, non-caring idiots who did this to ourselves?

And I’ve been thinking about a comment I got, years ago, on a column I wrote about Type 2. “I wish,” the writer huffed, “that all my daughter had to do was take a pill and not eat cheesecake.”

Yeah. I wish, too! Although cheesecake is good. I have a slice or two — a year.

Admittedly, I was once clueless and non-caring. That was when my diabetes self-management “education” consisted of: “Here. Follow this. Don’t eat any sugar.”

Nine years later, when I got to a place where I had some real education knocked into my skull, my HbA1c was 17.4%. As a comparison, now that I know about diabetes, my HbA1c last week was 6.2%. That was the same as the time before. I told the lab person that it was getting boring and we should perhaps tell Doc the next time that it was 10.6% or something and get his heart pumping.

So, being taught about diabetes and how different things affect control was a big help in lowering my HbA1c. Probably more important was teaching me how to fit diabetes into my lifestyle. There are people who can fit their lifestyles into diabetes. I’m not one of those people.

My fault? Sorry, but I have too many family members with Type 2 diabetes to fall for that old story. Plus, there are the numbers from the Centers for Disease Control and Prevention (CDC) showing that only about half of those considered overweight or obese have diabetes. Why don’t the rest? No genes?

Now, there are studies saying that Type 2 diabetes has a genetic component. Still, I find myself yelling at the television set when national news folks regurgitate the old “get fat, get diabetes” standard instead of the more recent “genetics combined with lifestyle” blurb.

But that’s a topic for another blog. In the meantime, I need to figure out what else is going on with me. I just got my lab results yesterday and haven’t yet had time to figure out what the highs and lows are.

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jim snell

Jan: Curious blog and comments.

From my seat in peanut gallery fighting the mess for the last 30 years and finally arresting mess somewhat, your column makes some good points.

1. Its your fault. Nope. If you know excatly what is wrong and got the complex solution to fixing it/tuning it, then yes, if you ignore that then maybe a case.
Presnt knowledge peddled is a 3 organ mentality of stomach, Intestine, pancreas simply provides no clue how to manually run this mess. Just add pills or insulin, right – where has that got us on the type 2 front.

2. Fat or being fat does not cause Type 2 diabetes although I am sure there are some nuts out there who managed to make that case. Extra weight simply shows that body is able to convert extra consumed glucose or leaked by liver and make into body fat.

3. We here all the blather about life style but totally ignore the massive change in sugar, grains and 24/7 availability of our rich refined foods science created to reduce starvation in our world and the massive drop of physical energy due to all the labour saving tools and couch potato computers, video games, wide screen tv’s. Right – its all your fault. Nonsense.

Real issue is energy balance in the body. Constant excess over production of glucose over what is burned can lead to saturation – type 2 diabetes.

Genes and aging mess up the picture that result in degredation of the body and how well it operates resulting in making the type 2 diabetes puzzle worse and harder to tune and fix and changing over time.

Thank you for your excellent column and wishing you every success in getting/keeping the monster arrested.

laura

i have sugar highs when i am stressed,but if i eat three meals a day & one apple i can keep my sugar right where i want it. so now when someone gets me stressed i just go for a walk & not hit snacks. i really enjoyed your blog,

jim snell

The other comment I meant to add is thank god I am not the only person who has had at least 26 years getting the mess under some control and starting at the sameplace you describe.

Yes I stopped the sugars early and missed the dam grains and other issues.

Once again , best wishes and all the luck fighting your situation.

RedneckAngel

Yeh, as a nurse with a MSN in Community Health AND havng had diabetes for 40+ years, I get mad, really mad, too when I have to listen to people try to blame the disease on the symptoms (too fat/too fat in the wrong places, not eating “right”, etc.). However, trust me, no one wants to hear that diabetes is not (easily!?!) cureable by a few life-style changes…
That said, I am having sudden trouble with my BSs too; very similar to yours. To add to my problems, Medicare does not want to pay for more than 5 test strips a day. The only thing that “works” is more frequent testing & being more aggressive with insulin.
I have a question for you; how did you ever get approved for a pump? My Endo tried to get me approved for one but since I an a type-2 (also), Medicare won’t pay for one. Won’t even pay for the supplies if I get one on my own.

Jan Chait

Redneck, I’ve been pumping since 1998. How did I get approved? Good insurance coverage — plus, I still am not old enough for Medicare (although I will be late this year).

Will I be able to have Medicare cover my pump? I don’t know. It will cover pumps for Type 2s under some circumstances, which includes having a low C-peptide and/or frequent hypoglycemia.

I’ve always paid for supplies out of pocket because my insurance coverage had a cap on costs so I won’t be missing that. I recently got a new pump, so I’m good to go for a few years.

You can try searching for “Type 2 diabetes insulin pumps” or going to http://www.medicare.gov and searching there. I tried for some time, but didn’t find what I was looking for.

Have you ever thought about getting a cheap meter — like a Walmart brand — to allow you to check more often for less cost? Take what Medicare gives you, then supplement with a low-cost meter and strips.

I should have known it would be on insulin-pumpers.org. I belong to that. It’s a great place for pumpers and wannabe pumpers.

Jan

LADAinBC

From your blog:
“As an insulin-resistant Type 2, I use a lot of insulin. My basal rate alone had been in the 150-unit-per-day range.”

Wow… might want to check your diet, especially amount of carbs. Even if you produce no insulin yourself, there is certainly a problem with what you are eating. Bet you have a bad time trying to control weight.

Tandi

12-yrs ago I was being worked-up for a slew of subjective complaints that had drastically effected my ability to work (RN, CCM). Primarily my complaints were due to cognitive/memory issues & baffled my many MD’s. Over time & along the way I was found to have hypothyroidism, hypercholesterolemia & diabetes 2. All that I could think at the time was ‘they’re finding all of these things wrong w/ my health, but none of these new diagnoses answered the cognitive or memory issues. So I am on meds for cholesterol, thyroid & diabetes (Metformin 750mg BID). In total it took 6-yrs to finally reach the diagnosis of “Mild Cognitive Impairment (MCI)”, although there is no mild about it for me & essentially no treament for it either. MCI on top of my other health issues caused my inability to work in my mid-50’s, becoming medically disabled.
I have written all of the above in order to provide an abbreviated account of my journey w/ diabetes. W/ my initial diagnosis I immediately stopped all sugary sodas, overhauled my diet & eating habits & in a short time lost 40#’s. Yippee!! I have since gained back 20 of those pounds & would love to lose 10, however my weight has remained steady for 8-yrs. The dosage of my Metformin has been adjusted twice, but has not changed in 3-yrs. My last A1C was 5.4 & has steadily decreased from my high of 7.4. I very fortunately have had an ‘easy ride’ w/ diabetes. I have some peripheral neuropathy in both feet & lower legs. 10-days ago I had a double discectomy w/ fusions & hardware at both levels. Whether this is connected to my diabetes, I have no clue, but there are no accidents/injuries in my past either.
Regarding the MCI, as stated before there is no treatment, but once diagnosed I was asked to join a longitudinal study through the Alzheimer’s Disease Center (ADC). All of my medical care has been provided at a medical university setting. I said yes to the ADC & am on my 7th year of study, which has been very interesting & educational. Needless to say I am much more concerned about the MCI, how it will progress, the effects it will have, if it will become Alzheimer’s, etc. So much more concerned that all other health issues have taken a back-seat. So it seems to me the oral medications & dietary changes were enough for me to gain control & remain steady.
For those who struggle day-to-day w/ control of their diabetes, my heart goes out to you, as I am sure that it is exhausting.

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